title: Health services use associated with emergency department closure.
abstract: OBJECTIVE
  To study changes in health services consumption following substantial reduction in the availability of local emergency services in a small municipality population.
  
  
  METHODS
  A dynamic cohort (21,000 residents of Viborg County, Denmark, of which 2,300 from Morsø municipality) was followed, 1997-2003. Data were extracted from administrative registries including information on individual use of emergency services and other hospital care, contact with GPs and socioeconomic background. Health services' use by the Morsø population was measured before reduction in emergency room opening hours, during a period of reduced opening hours and after closure, compared with the rest of Viborg County.
  
  
  RESULTS
  Emergency service use did not change among Morsø municipality residents compared to other Viborg County residents. Compared to men in other parts of the county, Morsø men did not change their use of substitute health services. By contrast, Morsø women compared to the rest of Viborg county reduced their use of GP services in terms of face-to-face visits (β = -0.08, P = 0.020), telephone consultations (β = -0.11, P = 0.007), home visits (β = -0.48, P = 0.009), and their inpatient hospital utilization (β = -0.12, P = 0.022) during the period when emergeny services were only available in the daytime.
  
  
  CONCLUSIONS
  Emergency services at neighbouring hospitals (40 kilometres distance) were able to compensate, in part, for the decreased local emergency service provision. Concurrent changes in health care utilization patterns were observed among local residents that varied by gender.
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Kristian Schultz
authors.initials: KS
authors.lastname: Hansen
authors.forename: Ulrika
authors.initials: U
authors.lastname: Enemark
authors.forename: Anders
authors.initials: A
authors.lastname: Foldspang
mesh_terms: D015331:Cohort Studies; D003718:Denmark; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012737:Sex Factors